Social determinants of health can be a variety of different things that lead to complications and poor quality of life. From the suggested article written by the World Health Organization, social determinants of health can have to do with the social gradient, stress, lifestyle and environment, food, and so many other factors that intersect and manipulate a person’s quality of life. (Activity PDF 6.3) For my final project, I have chosen to write about maternal mortality in India. The maternal mortality rate in rural parts of the country are higher than the urban parts. There are many social determinants of health that play a factor in the high rates seen in both the urban and rural parts of the country. In this post, I will discuss what social determinants of health I believe can be directly related to the high maternal mortality rates.
To begin, the social determinants I chose to focus most closely on is the social gradient within the country, stress, and transport. (Activity PDF 6.3) The social gradient looks at a person’s economic wealth and compares it with their health. On the table in the WHO article, they have used life expectancy to show how a person’s occupation and wealth can be directly related to the number of years they live. (Activity PDF 6.3) People with the least skills and who make the least amount of money often die at an earlier age than those with professional careers. (Activity PDF 6.3) The second determinant I chose to discuss is stress, which the WHO article attributes to both psychosocial and material needs and the feelings that are present when they are lacking. (Activity PDF 6.3) The final determinant I wanted to cover is transport, which the WHO article has linked with a heavy dependence on driving. In India, the problem is the lack of reliable and efficient transportation, so I will be looking at it a little differently than from what the WHO article suggests.
In India, it has been found that nearly a quarter of the population lives below the poverty line. (Pathak et al., 2010, Pg. 2) The article has configured that more than half of the country lives in poverty, which means that in most cases, women are not seeking maternal care services necessary for a healthy and successful birth experience. (Pathak et al., 2010, Pg. 2) In areas where income is higher and the residents all live above poverty, the maternal mortality rates were extremely low in comparison. (Pathak et al., 2010, Pg. 2) Comparing the maternal mortality rates of those families in poverty and those who are not, it is safe to say that income is an important factor on the quality of services and care that individuals will seek during pregnancy and for delivery. This brings me to the second social determinant which is stress. This is directly related with the family income and how much money the family can afford to spend on health services during pregnancy and delivery. In a family that has low income, they are likely to stress about health services and how they will afford to deliver a child if there are complications. There may be additional physiological stress on the mother if she is forced to work long and demanding hours to provide for her family so they have food on their tables. In many ways, lacking income and having to stress about material needs will likely result in psychological and physiological stress that can exacerbate the rates of maternal mortality.
The final social determinant of health I wanted to discuss was transportation. For all of the reading I have done on this topic, I have noticed that a large majority of the issues stemming from the rural maternal mortality rates is due to transportation. Whether there is no form of transportation available, whether the health services were too far away given their limited amount of time, or whether the roads are in such poor conditions that travel is unsafe. Whatever the cause may be, transportation seems to play a role in the high maternal mortality rates—especially in rural parts of the country. In an article by Kaur et al. that analyzed different social factors on maternal mortality, they had 10% of their deaths occur as a result of transportation delays. (Kaur et al. 2018, Pg. 10) This rate shows significance in the transportation that is available to families living in areas that must travel in order to seek care. Making this a social determinant that has an effect on the maternal mortality rates in India.
Sources Cited:
Activity PDF 6.3 WHO (2003) – “Social Determinants of Health: The Solid Facts”
Kaur, M., Gupta, M., Pandara Purayil, V., Rana, M., & Chakrapani, V. (2018). Contribution of social factors to maternal deaths in urban India: Use of care pathway and delay models. PloS one, 13(10), e0203209. doi:10.1371/journal.pone.0203209
Pathak PK, Singh A, Subramanian SV (2010) Economic Inequalities in Maternal Health Care: Prenatal Care and Skilled Birth Attendance in India, 1992–2006. PLoS ONE 5(10): e13593. doi:10.1371/journal.pone.0013593